Good posture consists of balancing the body weight around the body’s centre of gravity in the lower spine and pelvis.
Maintaining good posture helps prevent neck pain and back pain.
The presentation of dystonia may be focal (usually in adults) causing blepharospasm (forceful eye closure), oromandibular dystonia (spasms of the tongue and jaw), cranial dystonia/Meige syndrome/Brueghel’s syndrome (eyes and jaw both involved), spastic or spasmodic dysphonia/laryngeal dystonia (strained or whispering speech), spasmodic dysphagia (di?culty swallowing), spasmodic torti/latero/ ante/retrocollis (rotation, sideways, forward or backward tilting of the neck), dystonic writer’s cramp or axial dystonia (spasms deviating the torso). Foot dystonia occurs almost exclusively in children and adolescents. In adults, the condition usually remains focal or involves at most an adjacent body part. In children, it may spread to become generalised. The condition has always been considered rare, but commonly is either not diagnosed or mistakenly thought to be of psychological origin. It may, in fact, be half as common as MULTIPLE SCLEROSIS (MS). Similar features can occur in some subjects treated with major tranquillising drugs, in whom a predisposition to develop dystonia may be present.
One rare form, called dopa-responsive dystonia, can be largely abolished by treatment with LEVODOPA. Particularly in paediatric practice this drug will often be tried on a child with dystonia.... dystonia
Hypotension in healthy people does not require treatment, although affected individuals should be advised not to stand up suddenly or get out of a bath quickly. Someone who faints as a result of a hypotensive incident should be laid down for a few minutes to allow the circulation to return to normal. Hypotension resulting from burns, blood loss, heart attack or adrenal failure (shock) requires medical attention for the causative condition.... hypotension
This curvature is normally present to a minor degree in the lower back, but lordosis can become exaggerated by poor posture or by kyphosis higher in the back.
Pronounced lordosis is usually permanent and can lead to disc prolapse or osteoarthritis of the spine.... lordosis
A child with cerebral palsy may have spastic paralysis (abnormal stiffness of muscles), athetosis (involuntary writhing movements), or ataxia (loss of coordination and balance). Other nervous system disorders, such as hearing defects or epileptic seizures, may be present. About 70 per cent of affected children have mental impairment, but the remainder are of normal or high intelligence.
In most cases, damage occurs before or at birth, most commonly as a result of an inadequate supply of oxygen to the brain. More rarely, the cause is a maternal infection spreading to the baby in the uterus. In rare cases, cerebral palsy is due to kernicterus. Possible causes after birth include encephalitis, meningitis, head injury, or intracerebral haemorrhage. Cerebral palsy may not be recognized until well into the baby’s 1st year. Initially, the infant may have hypotonic (floppy) muscles, be difficult to feed, and show delay in sitting without support.
Although there is no cure for cerebral palsy, much can be done to help affected children using specialized physiotherapy, speech therapy, and techniques and devices for nonverbal communication.... cerebral palsy
SCALDS; CHEST, DEFORMITIES OF; TALIPES; FLAT-FOOT; JOINTS, DISEASES OF; KNOCK-KNEE; LEPROSY; PALATE, MALFORMATIONS OF; PARALYSIS; RICKETS; SCAR; SKULL; SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.)... deformities
The description ‘diaphragm’ is also used for the hemispherical rubber (‘dutch’) cap used in conjunction with a chemical spermicide as a contraceptive. It ?ts over the neck of the uterus (cervix) inside the vagina. (See CONTRACEPTION.)... diaphragm
Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.
In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.
The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.
Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.
The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.
Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.
Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.
Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.
Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).
Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.
In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:
the nature of the work.
how the tasks are performed in practice.
the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).
what control measures are in place and the extent to which these are adhered to.
previous occupational and non-occupational exposures.
whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,
for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.
Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that
19.5 million working days were lost as a result. The ten most frequently reported disease categories were:
stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.
back injuries: 508,000.
upper-limb and neck disorders: 375,000.
lower respiratory disease: 202,000.
deafness, TINNITUS or other ear conditions: 170,000.
lower-limb musculoskeletal conditions: 100,000.
skin disease: 66,000.
headache or ‘eyestrain’: 50,000.
traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.
vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu
pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.
While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:
CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.
hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.
LEPTOSPIROSIS – infection with Leptospira (various listed occupations).
viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.
LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.
asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.
mesothelioma from exposure to asbestos.
In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.
There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.
The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.
Inhaled materials
PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.
Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).
The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)
Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.
Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)
Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.
Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.
Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.
Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.
Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).
Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.
Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.
Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.
Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury
(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases
Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.
Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)
Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.
A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.
Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.
Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.
Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.
Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.
Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of
Acute pain is caused by internal or external injury or disease. It warns the individual that harm or damage is occurring and stimulates them to take avoiding or protective action. With e?ective treatment of disease or injury and/or the natural healing process, the pain resolves – although some acute pain syndromes may develop into chronic pain (see below). Stimuli which are su?ciently intense potentially to damage tissue will cause the stimulation of speci?c receptors known as NOCICEPTORS. Damage to tissues releases substances which stimulate the nociceptors. On the surface of the body there is a high density of nociceptors, and each area of the body is supplied by nerves from a particular spinal segment or level: this allows the brain to localise the source of the pain accurately. Pain from internal structures and organs is more di?cult to localise and is often felt in some more super?cial structure. For example, irritation of the DIAPHRAGM is often felt as pain in the shoulder, as the nerves from both structures enter the SPINAL CORD at the same level (often the structures have developed from the same parts of the embryo). This is known as referred pain.
The impulses from nociceptors travel along nerves to the spinal cord. Within this there is modulation of the pain ‘messages’ by other incoming sensory modalities, as well as descending input from the brain (Melzack and Walls’ gate-control theory). This involves morphine-like molecules (the ENDORPHINS and ENKEPHALINS) amongst many other pain-transmitting and pain-modulating substances. The modi?ed input then passes up the spinal cord through the thalamus to the cerebral cortex. Thus the amount of pain ‘felt’ may be altered by the emotional state of the individual and by other incoming sensations. Once pain is perceived, then ‘action’ is taken; this involves withdrawal of the area being damaged, vocalisation, AUTONOMIC NERVOUS SYSTEM response and examination of the painful area. Analysis of the event using memory will occur and appropriate action be taken to reduce pain and treat the damage.
Chronic pain may be de?ned in several ways: for example, pain resistant to one month’s treatment, or pain persisting one month beyond the usual course of an acute illness or injury. Some doctors may also arbitrarily choose the ?gure of six months. Chronic pain di?ers from acute pain: the physiological response is di?erent and pain may either be caused by stimuli which do not usually cause the perception of pain, or may arise within nerves or the central nervous system with no apparent external stimulation. It seldom has a physiological protective function in the way acute pain has. Also, chronic pain may be self-perpetuating: if individuals gain a psychological advantage from having pain, they may continue to do so (e.g. gaining attention from family or health professionals, etc.). The nervous system itself alters when pain is long-standing in such a way that it becomes more sensitive to painful inputs and tends to perpetuate the pain.
Treatment The treatment of pain depends upon its nature and cause. Acute pain is generally treated by curing the underlying complaint and prescribing ANALGESICS or using local anaesthetic techniques (see ANAESTHESIA – Local anaesthetics). Many hospitals now have acute pain teams for the management of postoperative and other types of acute pain; chronic pain is often treated in pain clinics. Those involved may include doctors (in Britain, usually anaesthetists), nurses, psychologists and psychiatrists, physiotherapists and complementary therapists. Patients are usually referred from other hospital specialists (although some may be referred by GPs). They will usually have been given a diagnosis and exhausted the medical and surgical treatment of their underlying condition.
All the usual analgesics may be employed, and opioids are often used in the terminal treatment of cancer pain.
ANTICONVULSANTS and ANTIDEPRESSANT DRUGS are also used because they alter the transmission of pain within the central nervous system and may actually treat the chronic pain syndrome.
Many local anaesthetic techniques are used. Myofascial pain – pain affecting muscles and connective tissues – is treated by the injection of local anaesthetic into tender spots, and nerves may be blocked either as a diagnostic procedure or by way of treatment. Epidural anaesthetic injections are also used in the same way, and all these treatments may be repeated at intervals over many months in an attempt to cure or at least reduce the pain. For intractable pain, nerves are sometimes destroyed using injections of alcohol or PHENOL or by applying CRYOTHERAPY or radiofrequency waves. Intractable or terminal pain may be treated by destroying nerves surgically, and, rarely, the pain pathways within the spinal cord are severed by cordotomy (though this is generally only used in terminal care).
ACUPUNCTURE and TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) are used for a variety of pain syndromes, particularly myofascial or musculoskeletal pain. It is thought that they work by increasing the release of endorphins and enkephalins (see above). It is possible to implant electrodes within the epidural space to stimulate directly the nerves as they traverse this space before passing into the spinal cord.
Physiotherapy is often used, particularly in the treatment of chronic backache, where pain may be reduced by improving posture and strengthening muscles with careful exercises. Relaxation techniques and psychotherapy are also used both to treat chronic pain and to help patients cope better with their disability.
Some types of chronic pain are caused by injury to sympathetic nerves or may be relieved by interrupting conduction in sympathetic nerves. This may be done in several ways. The nerves may be blocked using local anaesthetic or permanently destroyed using alcohol, phenol or by surgery.
Many of these techniques may be used in the management of cancer pain. Opioid drugs are often used by a variety of routes and methods, and management of these patients concentrates on the control of symptoms and on providing a good quality of life.... pain
Symptoms may occur if the rib begins to press on the lower brachial plexus (the group of nerves passing from the spinal cord into the arm), causing pain, numbness, and pinsand-needles in the forearm and hand.
Exercises to strengthen the shoulder muscles and improve posture may bring relief.
Severe or persistent symptoms may require surgery to remove the rib.... cervical rib
Causes The disease is caused by the bacillus Clostridium tetani, found generally in earth and dust and especially in places where animal manure is collected. Infection usually follows a wound, especially a deeply punctured or gunshot wound, with the presence of some foreign body. It is a hazard in war and also among farmers, gardeners and those in the construction industry. The bacillus develops a toxin in the wound, which is absorbed through the motor nerves into the spinal cord where it renders the nerves excitable and acutely sensitive to mild stimuli.
Symptoms Most commonly appearing within four to ?ve days of the wound, the patient’s symptoms may be delayed for several weeks – by which time the wound may have healed. Initially there is muscle sti?ness around the wound followed by sti?ness around the jaw, leading to lockjaw, or trismus. This extends to the muscles of the neck, back, chest, abdomen, and limbs, leading to strange, often changing, contorted postures, accompanied by frequent seizures – often provoked by quite minor stimuli such as a sudden noise. The patient’s breathing may be seriously affected, in severe cases leading to ASPHYXIA; the temperature may rise sharply, often with sweating; and severe pain is common. Mental clarity is characteristic adding to the patient’s anxiety. In severe infections death may be from asphyxia, PNEUMONIA, or general exhaustion. More commonly, the disease takes a chronic course, leading to gradual recovery. Outcome depends on several factors, chie?y the patient’s immune status and age, and early administration of appropriate treatment.
Tetanus may occur in newborn babies, particularly when birth takes place in an unhygienic environment. It is particularly common in the tropics and developing countries, with a high mortality rate. Local tetanus is a rare manifestation, in which only muscles around the wound are affected, though sti?ness may last for several months. STRYCHNINE poisoning and RABIES, although similar in some respects to tetanus, may be easily distinguished by taking a good history.
Prevention and treatment The incidence of tetanus in the United Kingdom has been almost abolished by the introduction of tetanus vaccine (see IMMUNISATION). Children are routinely immunised at two, three and four months of age, and boosters are given later in life to at-risk workers, or those travelling to tropical parts.
Treatment should be started as soon as possible after sustaining a potentially dangerous wound. An intravenous injection of antitoxin should be given immediately, the wound thoroughly cleaned and PENICILLIN administered. Expert nursing is most important. Spasms may be minimised by reducing unexpected stimuli, and diazepam (see BENZODIAZEPINES; TRANQUILLISERS) is helpful. Intravenous feeding should be started immediately if the patient cannot swallow. Aspiration of bronchial secretions and antibiotic treatment of pneumonia may be necessary.... tetanus
Deep wounds on the inner side of the thigh are dangerous by reason of the risk of damage to the large vessels. Pain in the back of the thigh is often due to in?ammation of the sciatic nerve (see SCIATICA). The veins on the inner side of the thigh are specially liable to become dilated.... thigh
Coccydynia may result from a blow to the base of the spine in a fall, from prolonged pressure due to poor posture when sitting, or the use of the lithotomy position during childbirth.
The pain usually eases in time.
Treatment may include heat, injections of a local anaesthetic, and manipulation.... coccydynia
The tumour usually arises from the cerebellum, which is concerned with posture, balance, and coordination.
It grows rapidly and may spread to other parts of the brain and to the spinal cord.
A morning headache, repeated vomiting, and a clumsy gait develop.
There are also frequent falls.
The tumour is diagnosed by CT scanning or MRI and often responds to radiotherapy.
Surgery and anticancer drugs may also be needed.... medulloblastoma
Information from proprioceptors (sensory nerve endings in the muscles, tendons, joints, and the inner ear) passes to the spinal cord and the brain.
The information is used to make adjustments so that posture and balance are maintained.... proprioception
Information is collected by millions of sense receptors found throughout body tissues and in special sense organs, such as the eye.
Certain sensory information, mainly that from the special sense organs and skin receptors, enters the sensory cortex of the brain, where sensations are consciously perceived.
Other types of sensory information, for example about body posture, are processed elsewhere and do not produce conscious sensation.... sensation
Symptoms. Persistent stiffness and pain in buttocks and low back. Poor chest expansion. Worse on rising and after inactivity. Rigidity develops over many years in neck and back.
The patient should be examined for bloodshot eyes. In the formative stages iritis is a classic diagnostic sign. An iritis which does not cause eyelids to be stuck down in the mornings is to be regarded with extreme caution. See: IRITIS.
Treatment. Anti-inflammatory analgesics: Guaiacum, White Willow bark, Wild Yam.
Teas. Bogbean, Celery seeds, Devil’s Claw root, German Chamomile, Meadowsweet, Prickly Ash bark, White Willow bark, Wild Yam.
Tablets/capsules. Black Cohosh, Devil’s Claw, Prickly Ash, Wild Yam, Bamboo gum.
Formula. White Willow 2; Celery 1; Black Cohosh half; Guaiacum quarter; Liquorice quarter. Mix. Dose: Powders – 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 15-60 drops. Tinctures: 1-2 teaspoons. Thrice daily.
Topical. Liniment. Tincture Black Cohosh 2; Tincture Lobelia 2; Tincture Capsicum quarter; Alcohol to 20.
Cold packs: See entry.
Aromatherapy. Massage oil: 6 drops Oil Lavender in 2 teaspoons Almond oil. Jojoba, Aloe Vera, Thyme, Peanut oil.
Diet. See: GENERAL DIET. Avoid lemons and other citrus fruits.
Supplements. Daily. Pantothenic acid 10mg; Vitamin A 7500iu; Vitamin B6 25mg; Vitamin E 400iu; Zinc 25mg. Cod Liver oil: 1 dessertspoon.
General. Graduated exercises to promote good posture and free breathing. Swimming; walk-tall; sleep with board under mattress; hot baths. Gentle osteopathy to delay consolidation of vertebrae. ... ankylosing spondylitis
Treatment. To activate capillary function and assist toxic elimination: Bladderwrack, Gotu Kola, Kola, Parsley tea. A diuretic may assist by eliminating excess fluid.
Gotu Kola tea: Quarter to half a teaspoon leaves to each cup boiling water; infuse 5-10 minutes. 1 cup morning and evening.
Formula. Tea. Equal parts: Alfalfa, Clivers, Fennel, Senna leaves. 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes. Half-1 cup morning and evening.
Seline. Tablets. Ingredients: Each tablet contains Lecithin 100mg; Pulverised Dandelion 100mg; Pulverised Horsetail 100mg; Pulverised extract Fucus 5:1 30mg; Vitamin C 40mg; Vitamin B6 1mg. 1 tablet thrice daily.
Aescin. Compound isolated from Horse-chestnuts to decrease capillary permeability and swelling. Topical. Decoction of Horse-chestnuts as a lotion. Or: infusion of Bladderwrack.
Aromatherapy and Herb essences. Combination for external use. Ingredients: Almond oil 47ml; Fennel oil 1ml; Juniper oil 1ml; Cypress essence 0.5ml; Lemon essence 0.5ml. Apply to affected areas morning and evening; small area 5 drops, large area 10 drops (Gerard). Gentle massage with a string glove, loofah or massage glove.
Diet. Reduce calorie intake. Raw fresh fruits and vegetable salads to account for 50 per cent of the diet. No sweet or dried fruits. Conservatively-cooked vegetables. Seafood. Iodine-rich foods. Wholegrain cereals. Protein: beans, chicken, poached eggs, fish, little lean meat: no pork, bacon or ham. Low-fat yoghurt. Cold-pressed unsaturated oils for salad dressings with lemon juice. Dandelion coffee to stimulate liver. Avoid sugar, alcohol, bananas and white flour products. Spring water.
Supportives. Stop smoking. Adopt an alternative to the contraceptive pill. To avoid fluid retention, 2-3 glasses of water daily. ... cellulite
Alternatives. To strengthen ligaments: Comfrey (topical). Wild Yam, Irish Moss, Slippery Elm bark, Horsetail, Fenugreek seeds. St John’s Wort, Ginseng.
Supplementation. Calcium and Zinc, Vitamin C (1 gram thrice daily).
DISMUTASE ENZYMES (SOD). A dismutase enzyme is a biologically active enzyme complex present in most human cells and capable of converting tissue-damaging oxygen free radicals (highly reactive cellular toxins) into less harmful chemical substances that can be excreted from the body through the usual eliminatory channels.
Evidence shows that a number of chronic diseases including MS, diabetes, arthritis, even cancer, are the result of free radical damage. SOD is derived from a natural wheat sprout extract from specially cultured wheat that is hypoallergenic. It stimulates and supports the immune system, neutralises toxins, and minimises tissue damage in wasting diseases and organ transplantation. Protecting oxygen levels in body cells, it allays the ageing process and alleviates circulatory disorders. ... dislocations
Causes: foot-strain, deformity, osteoporosis, high heels throwing the body out of its normal posture, tight shoes.
Feet are often painful because one or more of the bones are out of alignment and which may be adjusted by simple osteopathy. The process can be assisted by foot-baths of Chamomile flowers, Arnica flowers, or Comfrey to relax muscles and tendons.
Alternatives. Alfalfa, Chaparral, Ligvites, Prickly Ash.
Topical. Aromatherapy. (Sensitive feet) Oils of Pine, Eucalyptus or Thyme – 6 drops, any one, to 2 teaspoons Almond oil. Warm. Massage into foot and wrap round with damp hot towel.
General. Acupuncture. Shoes should be bought in the afternoon, particularly if feet swell during the day. Shoes that fit well in the morning may have become too tight by tea-time. ... feet – pain in
Symptoms. Hard rubbery glands are general, chiefly detected under the arm and groin. Enlarged nodes may compress nearby structures to produce nerve pains. Weight loss. Accumulation of fluid in lungs and abdomen. Obstruction of bile duct leads to jaundice. Patient may be prone to shingles. High fever heralds approaching fatality. Blood count, bone marrow aspiration and node biopsy confirm. Tubercula glands may simulate Hodgkin’s disease.
Some success reported by the use of the Periwinkle plant. (vinca rosea – Vinchristine) Wm Boericke, M.D. refers to Figwort as a powerful agent in Hodgkin’s disease.
Alternatives. Although there is no known cure, emphasis on the cortex of the adrenal gland may reduce skin irritation and pain in the later stages (Gotu Kola, Liquorice, Sarsaparilla). To arrest wasting and constitutional weakness: Echinacea. Anti-pruritics, alteratives and lymphatics are indicated.
Tea. Formula. Equal parts, Nettles, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.
Decoction. Formula. Equal parts – Yellow Dock, Queen’s Delight, Echinacea. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup 3 or more times daily.
Tablets/capsules. Poke root. Blue Flag root. Echinacea. Mistletoe.
Powders. Formula. Echinacea 2; Poke root 1; Bladderwrack 1. Dose: 500mg (two 00 capsules or one- third teaspoon) 3 or more times daily.
Tinctures. Mixture. Parts: Echinacea 2; Goldenseal quarter; Thuja quarter; Poke root half; Periwinkle 1. Dose: 1-2 teaspoons, 3 or more times daily. Where active inflammation is present – add Wild Yam 1. External. Castor oil packs to abdomen.
Treatment by a general medical practitioner or hospital specialist.
HOLISTIC MEDICINE. A school of thought which regards disease as a manifestation of an inner disturbance of the vital force, and not merely abnormality of certain groups of nerves, muscles, veins, or even the mind itself. Article 43 of Dr Samuel Hahnemann’s Organon of the Healing Art describes it:
“No organ, no tissue, no cell, no molecule is independent of the activities of the others but the life of each one of these elements is merged into the life of the whole. The unit of human life cannot be the organ, the tissue, the cell, the molecule, the atom, but the whole organism, the whole man.”
Holistic medicine relates disease to a patient’s personality, posture, diet, emotional life, and lifestyle. Treatment will be related to body, mind and spirit. It encourages a positive psychological response to the disease from which a patient suffers. For instance, its gentle approach to cancer embraces stress control, meditation, forms of visualisation and other life-enhancing skills.
Diet may be vegetarian, even vegan.... hodgkin’s disease
An adult brain weighs about 1.4 kg and has 3 main structures: the largest part, the cerebrum, consisting of left and right hemispheres; the brainstem; and the cerebellum. Each hemisphere in the
cerebrum has an outer layer called the cortex, consisting of grey matter, which is rich in nerve-cell bodies and is the main region for conscious thought, sensation, and movement. Beneath the cortex are tracts of nerve fibres called white matter, and, deeper within the hemispheres, the basal ganglia. The surface of each hemisphere is divided by fissures (sulci) and folds (gyri) into distinct lobes (occipital, frontal, parietal, and temporal lobes), named after the skull bones that overlie them. A thick band of nerve fibres called the corpus callosum connects the hemispheres.
The cerebrum encloses a central group of structures that includes the thalami and the hypothalamus, which has close connections with the pituitary gland. Encircling the thalami is a complex of nerve centres called the limbic system. These structures act as links between parts of the cerebrum and the brainstem lying beneath the thalami.
The brainstem is concerned mainly with the control of vital functions such as breathing and blood pressure. The cerebellum at the back of the brain controls balance, posture, and muscular coordination. Both of these regions operate at a subconscious level.
The brain and spinal cord are encased in 3 layers of membranes, known as meninges.
Cerebrospinal fluid circulates between the layers and within the 4 main brain cavities called ventricles.
This fluid helps to nourish and cushion the brain.
The brain receives about 20 per cent of the blood from the heart’s output.... brain
Added to the above are:– muscular rigidity, loss of reflexes, drooling – escape of saliva from the mouth. Muscles of the face are stiff giving a fixed expression, the back presents a bowed posture. The skin is excessively greasy and the patient is unable to express emotional feelings. Loss of blinking. Pin- rolling movement of thumb and forefinger.
Causes: degeneration of groups of nerve cells deep within the brain which causes a lack of neurotransmitting chemical, dopamine. Chemicals such as sulphur used by agriculture, drugs and the food industry are suspected. Researchers have found an increase in the disease in patients born during influenza pandemics.
Treatment. While cure is not possible, a patient may be better able to combat the condition with the help of agents that strengthen the brain and nervous system.
Tea. Equal parts: Valerian, Passion flower, Mistletoe. 1 heaped teaspoon to each cup water; bring to boil; simmer 1 minute; dose: half-1 cup 2-3 times daily.
Gotu Kola tea. (CNS stimulant).
Tablets/capsules. Black Cohosh, Cramp bark, Ginseng, Prickly Ash, Valerian.
Formula. Ginkgo 2; Black Cohosh 1; Motherwort 2; Ginger 1. Mix. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-3 teaspoons in water or honey. Fava Bean Tea.
Case report. Two patients unresponsive to Levodopa treatment reported improvement following meals of fresh broad beans. (Vicia faba) The beans contain levodopa in large amounts. (Parkinson Disease Update Vol 8, No 66, p186, Medical Publications, PO Box 24622-H, Philadelphia, USA) See also: BROAD BEANS. L-DOPA.
Nacuna Pruriens. Appropriate. Essential active constituent: L-dopa. (Medicinal plants and Traditional Medicine in Africa, by Abayomi Sofowora, Pub: John Wiley)
Practitioner. To reduce tremor: Tincture Hyoscyamus BP. To reduce spasm: Tincture Belladonna BP. To arrest drooling: Tincture Stramonium BP.
Diet. It is known that people who work in manganese factories in Chile may develop Parkinson’s disease after the age of 30. Progress of the disease is arrested on leaving the factory. Two items of diet highest in manganese are wheat and liver which should be avoided, carbohydrates in place of wheat taking the form of rice and potatoes.
Supplements. Daily: B-complex, B2, B6, niacin. C 200mg to reduce side-effects of Levodopa. Vitamin E 400iu to possibly reduce rigidity, tremors and loss of balance.
Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan.
Antioxidants. Evidence has been advanced showing how nutritional antioxidants, high doses of Vitamin C and E, can retard onset of the disease, delaying the use of Levodopa for an average of 2 and a half years. (Fahn S., High Dose Alpha-tocopherol and ascorbate in Early Parkinson’s Disease – Annals of Neurology, 32-S pp128-132 1992)
For support and advice: The Parkinson’s Disease Society, 22 Upper Woburn Place, London WC1H 0RA, UK. Send SAE. ... parkinson’s disease
The cerebellum is situated behind the brainstem and has 2 hemispheres.
From the inner side of each hemisphere arise 3 nerve fibre stalks, which link up with different parts of the brainstem and carry signals between the cerebellum and the rest of the brain.
Nerve fibres from these stalks fan out towards the deep folds of the cortex (outer part) of each brain hemisphere, which consists of layers of grey matter.
Information about the body’s posture and the state of contraction or relaxation in its muscles is conveyed from muscle tendons and the labyrinth in the inner ear via the brainstem to the cerebellum.
Working with the basal ganglia (nerve cell clusters deep within the brain), the cerebellum uses this data to fine tune messages sent to muscles from the motor cortex in the cerebrum.... cerebellum
Symptoms of cervical osteoarthritis may include pain and stiffness in the neck, pain in the arms and shoulders, numbness and tingling in the hands, and a weak grip. Other symptoms such as dizziness, unsteadiness, and double vision when turning the head may also occur. Rarely, pressure on the spinal cord can cause weakness or paralysis in the legs and loss of bladder control.
Treatments include heat treatment and analgesics.
Physiotherapy may improve neck posture and movement.
Pressure on the spinal cord may be relieved by surgery (see decompression, spinal canal).... cervical osteoarthritis
Muscles most commonly affected are those in the neck, shoulders, chest, back, buttocks, and knees. There is usually no restriction of movement. Sometimes, attacks (which are generally worse in cold, damp weather) are accompanied by exhaustion and disturbed sleep.
Analgesic drugs, hot baths, and massage usually relieve pain and stiffness. Exercises to improve posture may help to prevent attacks. (See also back pain.)... fibrositis
Many headaches are simply a response to some adverse stimulus, such as hunger. Such headaches usually clear up quickly. Tension headaches, caused by tightening in the face, neck, and scalp muscles as a result of stress or poor posture, are also common, and may last for days or weeks. Migraine is a severe, incapacitating headache preceded or accompanied by visual and/or stomach disturbances. Cluster headaches cause intense pain behind 1 eye.
Common causes of headache include hangover and noisy or stuffy environments. Food additives may also be a cause. Some headaches are due to overuse of painkillers (see analgesic drugs). Other possible causes include sinusitis, toothache, cervical osteoarthritis, and head injury. Among the rare causes of headache are a brain tumour, hypertension, temporal arteritis, an aneurysm, and increased pressure within the skull.
Most headaches can be relieved by painkillers and rest. If a neurological cause is suspected, CT scanning or MRI may be performed.... headache
Parkinson’s disease A neurological disorder that causes muscle tremor, stiffness, and weakness. The characteristic signs are trembling, rigid posture, slow movements, and a shuffling, unbalanced walk. The disease is caused by degeneration of, or damage to, cells in the basal ganglia of the brain, reducing the amount of dopamine (which is needed for control of movement). It occurs mainly in elderly people and is more common in men.
The disease usually begins as a slight tremor of 1 hand, arm, or leg, which is worse when the hand or limb is at rest. Later, both sides of the body are affected, causing a stiff, shuffling, walk; constant trembling of the hands, sometimes accompanied by shaking of the head; a permanent rigid stoop; and an unblinking, fixed expression. The intellect is unaffected until late in the disease.
There is no cure.
Drug treatment is used to minimize symptoms in later stages.
Levodopa, which the body converts into dopamine, is usually the most effective drug.
It may be used in combination with benserazide or carbidopa.
The effects of levodopa gradually wear off.
Drugs that may be used in conjunction with it, or as substitutes for it, include amantadine and bromocriptine.
Surgical operations on the brain are occasionally performed.
Untreated, the disease progresses over 10 to 15 years, leading to severe weakness and incapacity.
About one third of sufferers eventually develop dementia.... parity
Blood tests and urinalysis are used to make a diagnosis.
CT scanning, MRI, and radioisotope scanning may be used to locate the tumours, which are then usually removed surgically.
Follow-up medical checks are required because the condition occasionally recurs.... phaeochromocytoma
Onset can be at any age but is most common in late adolescence and the early 20s, and may be triggered by stress. No causes have been identified, but many have been implicated. It is likely that inheritance plays a role. Disruption of the activity of some neurotransmitters in the brain is a possible mechanism. Brain imaging techniques have revealed abnormalities of structure and function in people with schizophrenia.
Schizophrenia may begin insidiously, with the individual becoming slowly more withdrawn and losing motivation. In other cases, the illness comes on more suddenly, often in response to external stress. The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. Disordered thinking is often reflected in muddled and disjointed speech. Behaviour is eccentric, and selfneglect common. In a rare form of schizophrenia, catatonia may occur, in which rigid postures are adopted for prolonged periods, or there are outbursts of repeated movement.
Diagnosis of schizophrenia may take some time and, in some cases, it may be difficult to make a diagnosis at all.
Treatment is mainly with antipsychotic drugs, such as phenothiazine drugs, and new atypical antipsychotic drugs such as risperidone. In some cases, the drugs are given as monthly depot injections. Once the symptoms are controlled, community care, vocational opportunities, and family counselling can help to prevent a relapse.
Some people may make a complete recovery. However, the majority have relapses punctuated with partial or full recovery. A small proportion have a severe life-long disability.... schizophrenia
Treatment of sciatica is with analgesic drugs. If the pain is severe, a short period of bed rest may be helpful, although prolonged rest may cause the condition to worsen. Physiotherapy, osteopathy, or chiropractic may help in some cases. It is important to maintain a healthy posture and weight.... sciatica
Treatment of thoracic outlet syndrome usually consists of exercises to improve posture, sometimes together with nonsteroidal anti-inflammatory drugs and muscle-relaxant drugs. Severe cases may be treated by surgical removal of the 1st rib.... thoracic outlet syndrome
walking Movement of the body by lifting the feet alternately and bringing 1 foot into contact with the ground before the other starts to leave it. A person’s gait is determined by body shape, size, and posture. The age at which children first walk varies enormously.
Walking is controlled by nerve signals from the brain’s motor cortex (see cerebrum), basal ganglia, and cerebellum that travel via the spinal cord to the muscles. Abnormal gait may be caused by joint stiffness, muscle weakness (sometimes due to conditions such as poliomyelitis or muscular dystrophy), or skeletal abnormalities (see, for example, talipes; hip, congenital dislocation of; scoliosis; bone tumour; arthritis). Children may develop knock-knee or bowleg; synovitis of the hip and Perthes’ disease are also common. Adolescents may develop a painful limp due to a slipped epiphysis (see femoral epiphysis, slipped) or to fracture or disease of the tibia, fibula or femur.
Abnormal gait may also be the result of neurological disorders such as stroke (commonly resulting in hemiplegia), parkinsonism, peripheral neuritis, multiple sclerosis, various forms of myelitis, and chorea.
Ménière’s disease may cause severe loss of balance and instability.... vulvovaginitis
In partial (or focal) seizures, the nature of the seizure depends upon the location of the damage in the brain. For example, a simple partial motor seizure consists of convulsive movements that might spread from the thumb to the hand, arm, and face (this spread of symptoms is called the Jacksonian march); there is no loss of awareness. Complex partial seizures are commonly caused by damage to the cortex of the temporal lobe or the adjacent parietal lobe of the brain: this form of epilepsy is often called temporal lobe (or psychomotor) epilepsy. Symptoms may include *hallucinations of smell, taste, sight, and hearing, paroxysmal disorders of memory, and *automatism. Throughout an attack the patient is in a state of clouded awareness and afterwards may have no recollection of the event (see also déjà vu; jamais vu). A number of these symptoms are due to scarring and atrophy (mesial temporal sclerosis) affecting the temporal lobe.
The different forms of epilepsy can be controlled by the use of antiepileptic drugs (see anticonvulsant). Surgical resection of focal epileptogenic lesions in the brain is appropriate in a strictly limited number of cases. See also aura; postictal phase. —epileptic adj., n.... epilepsy
l... kyphosis
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